ST LOUIS KIDNEY CARE LLC (NPI# 1780058727) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1780058727 |
| Entity Type | Organization |
| Organization Name | ST LOUIS KIDNEY CARE LLC |
| Practice Address |
11155 Dunn Rd Ste 211n Saint Louis MO 63136-6166 |
| Practice Telephone | 3147411600 |
| Practice Fax Number | 3147411677 |
| Mailing Telephone | 3147411600 |
| Mailing Fax Number | 3147411677 |
| Enumeration Date | 2015-11-13 |
| Last Update Date | 2020-04-03 |
| Authorized Official Name | KRISTI DMYTRIW (VP OF OPERATIONS) |
| Authorized Official Telephone | 3038092855 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RN0300X |
Internal Medicine Specialization: Nephrology |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | 455247262-04915-01 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 2 Memorial Dr Ste 201, Alton, IL 620026723 | 3147411600 | 3147411677 |
| 2044 Madison Ave Ste 15, Granite City, IL 620404641 | 6184528420 | 3147411677 |
| 3394 Mckelvey Rd Ste 115, Bridgeton, MO 630442531 | 3147411600 | 3147411677 |
| Street Address |
11155 DUNN RD STE 211N |
| City | SAINT LOUIS |
| State | MO |
| Zip Code | 63136-6166 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518565993 | Dorothy Smith | Home Health | 2531 Nathan Drive, St Louis, MO 63136 | 2020-10-16 |
| 1538784459 | Rita D Wilson | Technician | 9597 Jacobi Ave Bldg 33 Apt 7, Saint Louis, MO 63136 | 2020-06-16 |
| 1922646728 | Eduhealth Personal Care Services | Technician | 5843 Eagle Valley Dr Saint Louis Mo 63136, Saint Louis, MO 63136 | 2019-12-12 |
| 1558912964 | Homers Haven Home Care LLC | Home Health | 5636 Pamplin Pl, St Louis, MO 63136 | 2019-09-26 |
| 1366096703 | Chloe Suzanne Datillo | Nurse Practitioner | 2865 Netherton Dr., St Louis, MO 63136 | 2019-07-24 |
| 1053976431 | U Auto Be Quik LLC | Non-emergency Medical Transport (VAN) | 10352 Castle Drive, St. Louis, MO 63136 | 2019-05-01 |
| 1164945895 | A Plus Home Health Services LLC | Home Health | 9517 Wilson Bridge Drive, Saint Louis, MO 63136 | 2017-07-25 |
| 1184150302 | Fairview Village Adult Day Care LLC | Clinic/Center | 8449 Jennings Station Rd, Fairview Village Adult Day Care, Saint Louis, MO 63136 | 2017-05-08 |
| 1023541182 | Lots of Love Home Health Services | In Home Supportive Care | 4144 Lindell Blvd. Suite 218, Saint Louis, MO 63136 | 2017-04-06 |
| 1912440876 | Carestl Health | Clinic/Center | 7047 Emma Ave, Jennings, MO 63136 | 2016-11-28 |
| Find all providers in zip 63136 | ||||
| Taxonomy Code | 207RN0300X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Nephrology |
| An internist who treats disorders of the kidney, high blood pressure, fluid and mineral balance and dialysis of body wastes when the kidneys do not function. This specialist consults with surgeons about kidney transplantation. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033649819 | Taewoo Lee | Internal Medicine | 3635 Vista Ave Saint Louis University Medical Center, Division of Nephrology, Saint Louis, MO 63110 | 2017-06-14 |
| 1184056830 | Ralph Robert Hatlelid | Internal Medicine | 318 E Swon Ave, Saint Louis, MO 63119-3112 | 2013-08-05 |
| 1497000194 | Siddiq Anwar | Internal Medicine | 660 S Euclid Ave # 8129, Renal Fellowship Program, Saint Louis, MO 63110-1010 | 2012-07-18 |
| 1588764724 | Douglass Takashi Domoto | Internal Medicine | 2606 Clark Ave, Saint Louis, MO 63103-2502 | 2006-09-25 |
| 1699708016 | Bhajanlal S Dara | Internal Medicine | 10160 W Florissant Ave, Suite 200, Saint Louis, MO 63136-2104 | 2006-07-09 |
| 1962432807 | Guner Buyukkus Gulmen | Internal Medicine | 100 N Euclid Ave, Suite 800, Saint Louis, MO 63108-1529 | 2006-07-04 |
| 1710920947 | Rajalakshmi T Gopalakrishnan | Internal Medicine | 915, North Grand Boulevard, Saint Louis, MO 63106 | 2006-06-14 |
| 1457348286 | Kira S Mailey | Internal Medicine | 18 Chapel Hill Est, Saint Louis, MO 63131-1315 | 2005-10-06 |
| 1376166066 | Nhs South LLC | Internal Medicine | 10004 Kennerly Rd, Saint Louis, MO 63128-2141 | 2020-05-28 |
| 1760005706 | Mehmet Tamer | Internal Medicine | 1402 S Grand Blvd, Saint Louis, MO 63104-1004 | 2020-05-26 |
| Find all providers in SAINT LOUIS | ||||
| City | SAINT LOUIS |
| Zip Code | 63136 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.